Effectiveness of conventional versus virtual reality-based vestibular rehabilitation exercises in elderly patients with dizziness: a randomized controlled study with 6-month follow-up

Abstract Objectives: To investigate the effect of vestibular rehabilitation exercises supported with virtual reality containing real-life environments on dizziness, static and dynamic balance, functional mobility, fear of falling, anxiety, and depression in elderly patients with dizziness. Methods: In this prospective randomized controlled study, 32-patients aged 65-years and older who applied to the otorhinolaryngology clinic with dizziness complaint randomly assigned to 2 groups. In Group 1 (n = 16), vestibular rehabilitation program, supported with virtual reality, and in Group 2 (n = 16), conventional vestibular rehabilitation program was applied 30-min a day, 5 sessions per week, 15 sessions in total for 3 weeks. Subjects were evaluated with The Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Berg Balance Test (BBT) and Timed Up & Go Test (TUG), Falls Efficacy Scale-International (FES-I), Postural Stability Test (PST), Geriatric Depression Scale (GDS), Hamilton Anxiety Scale (HAS) at baseline, at the end of the treatment and 6-months after the treatment. Results: Statistically significant improvements were seen in the DHI emotional subscale and TUG in Group 1 compared to Group 2 at the end of the treatment in elderly with dizziness (p<0.05). Also, there were significant improvements in the VSS, all DHI subgroups, and total scores, BBT, HAS in Group 1 compared to Group 2 at the 6-months after the treatment (p<0.05). Conclusion: The application of vestibular rehabilitation in a virtual reality environment can lead to additional improvements especially in dizziness symptoms, disability, balance, and mobility in the elderly with chronic dizziness.

The Effects of Basic Photography Education on Quality of Life, Self-Esteem, Life Satisfaction and Moods in Children with Diplegic Cerebral Palsy: A Randomized Controlled Study.

AIMS: To investigate the effects of basic photography education and practices on health-related-quality-of-life (HRQoL), self-esteem, life satisfaction, and moods of children with diplegic cerebral palsy (CP). METHODS: Twenty children with diplegic CP who did not have an intellectual or communication disability were included in this prospective randomized controlled clinical study and divided into two equal groups using a computer-generated list of random numbers to receive either eight weeks of basic photographic training or a control group. Basic photography training including a total of 20 hours theoretical and 30 hours practice was given during the eight weeks in this study. HRQoL, self-esteem, life satisfaction, depression and anxiety were assessed at baseline and at the end of the training. RESULTS: At the end of the treatment, statistically significant improvements were found for self-reported HRQoL, life satisfaction, and self-esteem in the basic photographic training group compared to the control group (p < 0.05). However, no statistically significant between group difference was found for parents' version of the HRQoL (p > 0.05). CONCLUSIONS: The findings suggest that basic photography training can improve HRQoL, life satisfaction, and self-esteem in children with diplegic CP.

Effectiveness of conventional versus virtual reality-based vestibular rehabilitation exercises in elderly patients with dizziness: a randomized controlled study with 6-month follow-up.

OBJECTIVES: To investigate the effect of vestibular rehabilitation exercises supported with virtual reality containing real-life environments on dizziness, static and dynamic balance, functional mobility, fear of falling, anxiety, and depression in elderly patients with dizziness. METHODS: In this prospective randomized controlled study, 32-patients aged 65-years and older who applied to the otorhinolaryngology clinic with dizziness complaint randomly assigned to 2 groups. In Group 1 (n=16), vestibular rehabilitation program, supported with virtual reality, and in Group 2 (n=16), conventional vestibular rehabilitation program was applied 30-min a day, 5 sessions per week, 15 sessions in total for 3 weeks. Subjects were evaluated with The Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Berg Balance Test (BBT) and Timed Up & Go Test (TUG), Falls Efficacy Scale-International (FES-I), Postural Stability Test (PST), Geriatric Depression Scale (GDS), Hamilton Anxiety Scale (HAS) at baseline, at the end of the treatment and 6-months after the treatment. RESULTS: Statistically significant improvements were seen in the DHI emotional subscale and TUG in Group 1 compared to Group 2 at the end of the treatment in elderly with dizziness (p<0.05). Also, there were significant improvements in the VSS, all DHI subgroups, and total scores, BBT, HAS in Group 1 compared to Group 2 at the 6-months after the treatment (p<0.05). CONCLUSION: The application of vestibular rehabilitation in a virtual reality environment can lead to additional improvements especially in dizziness symptoms, disability, balance, and mobility in the elderly with chronic dizziness.

The effects of short-term back extensor strength training in postmenopausal osteoporotic women with vertebral fractures: comparison of supervised and home exercise program.

This study explores the effect of supervised back extensor strength training on spinal pain, back extensor muscle strength, trunk-arm endurance, kyphosis, functional mobility, and quality of life (QoL) among sixty postmenopausal women with vertebral osteoporotic fractures. PURPOSE: To compare the effects of a 6-week supervised or home-based program of back-strengthening exercise on spinal pain, back extensor strength, trunk-arm endurance, kyphosis, functional mobility, and QoL in osteoporotic postmenopausal women with vertebral fractures. METHODS: The study was designed as a randomized controlled clinical trial. Sixty osteoporotic postmenopausal women with vertebral fracture (mean age 60.3 ± 9.3 years) were included in the study. Subjects were randomly assigned into three groups (supervised program, home-based program, or control), each consisting of 20 subjects. The subjects underwent the 6-week exercise program which included strengthening exercise for the back extensor muscles. They performed three sets of 8, 10, or 12 repetitions for each of the exercises, biweekly ascending, three times per week. Spinal pain, back extensor strength, trunk and arm endurance, kyphosis, functional mobility, and QoL were measured at baseline and at the end of the exercise program. RESULTS: Statistically significant improvements were demonstrated on spinal pain, muscle strength and endurance, functional mobility, and QoL for the supervised exercise program compared with control and home-based exercise groups (p < 0.01). Home-based exercise program did not provide a significant improvement compared with the control group except for mobility parameters of QoL. CONCLUSIONS: Six-week supervised back extensor strengthening training is superior to home-based program in terms of spinal pain, back extensor muscle strength, trunk endurance, functional mobility, and QoL for postmenopausal osteoporotic women with vertebral fractures.

Comparison of effectiveness of Transcutaneous Electrical Nerve Stimulation and Kinesio Taping added to exercises in patients with myofascial pain syndrome.

BACKGROUND: Although there are several studies of Transcutaneous Electrical Nerve Stimulation (TENS) and exercise in myofascial pain syndrome, there are no studies comparing the effectiveness of Kinesio Taping (KT) and TENS in myofascial pain syndrome patients. OBJECTIVE: To compare the early and late effects of TENS and KT on pain, disability and range of motion in myofascial pain syndrome patients. METHODS: Sixty-nine patients were divided into three groups randomly as TENS+Exercise, KT+Exercise and exercise groups. Visual Analogue Scale (VAS), pain threshold, Neck Disability Index and cervical contralateral lateral flexion were employed in the evaluation of the patients performed before treatment, after treatment and 3rd month after treatment. RESULTS: The VAS, pain threshold, Neck Disability Index and contralateral lateral flexion values were improved in all groups both in after treatment and 3rd month after treatment (p< 0.01). In the comparison of after treatment vs. before treatment evaluations, VAS score was decreased in KT group compared to the TENS and control group (p= 0.001), in the TENS group compared to control group (p= 0.011). In the comparison of 3rd month and before treatment evaluations, VAS score was decreased in the TENS group compared to control group (p= 0.001) and in the KT group compared to the control group (p= 0.001). There was no significant difference between TENS and KT groups. All other parameters did not differ between the groups. CONCLUSIONS: TENS and KT added exercises can decrease pain severity and increase pain threshold, function and cervical range of motion in myofascial pain syndrome patients. Addition of TENS or KT to the exercise therapy resulted in more significant improvement compared to exercise therapy alone with a more pronounced improvement in KT group compared to the TENS group in the early period. Because KT was found to be more effective in decreasing the pain and had the advantage of being used in every 3 days, it seems to be beneficial in acute painful periods in myofascial pain syndrome patients.

Comparison of the effectiveness of active and passive neuromuscular electrical stimulation of hemiplegic upper extremities: a randomized, controlled trial.

To compare the efficacy of electromyography (EMG)-triggered (active) neuromuscular electrical stimulation (NMES) and passive NMES in enhancing the upper extremity (UE) motor and functional recovery of subacute and chronic stage stroke patients. Thirty-one hemiplegic patients were randomly assigned to active NMES (n=11), passive NMES (n=10), and control (sham stimulation) (n=10) groups. Each treatment regimen was applied five times per week for 45 min for 3 weeks. All of the patients performed the same neurophysiologic exercise program for 45 min five times per week for 3 weeks. Patients were assessed by the UE component of the Fugl-Meyer Motor Assessment (UE-FMA), the self-care component of the Functional Independence Measure (self-care FIM), the Motor Activity Log (MAL), goniometric measurements of active wrist and metacarpophalangeal joint extension, surface EMG potentials, grip strength, and the modified Ashworth scale in a blinded manner. Data were obtained before and at the end of the treatment. Participants were similar in all clinical and demographic features (P>0.05). All groups were comparable with respect to UE-FMA, MAL, self-care FIM, wrist and finger flexor spasticity, active range of motion (ROM), grip strength, and surface EMG potentials before treatment (P>0.05). The active ROM, grip strength, FMA, FIM, surface EMG potentials, and MAL: amount of use were significantly improved in the EMG-triggered NMES group compared with the controls (P<0.05). The active wrist extension ROM and FMA scores were significantly improved in the passive NMES group compared with the controls (P<0.05). There were no statistically significant differences between active and passive NMES groups in any of the parameters evaluated at the end of the treatment (P>0.05). Both active and passive NMES as adjuvant therapy in the neurophysiologic exercise program effectively enhanced the UE motor and functional recovery of stroke survivors.

Short- and long-term results of clinical effectiveness of sodium hyaluronate injection in supraspinatus tendinitis.

The objective of the study is to evaluate the short- and long-term effect of intraarticular sodium hyaluronate (SH) application in patients diagnosed with supraspinatus tendinitis (ST) that have shoulder pain on the clinical symptoms of the patients through comparison with conventional physiotherapy methods. A total of 24 patients were included in the study and were randomized into two groups.SH injection and physical therapy modalities (PTM) were administered to Group I and Group II, respectively. Home exercise programs were recommended to all of the patients in both groups. The patients were evaluated using the pain severity [Visual Analog Scale (VAS)], range of motion and functional evaluation (FE) parameters pertaining to pre-treatment, 3rd week, 3rd month and 4th year post-treatment. Patient's global effectiveness (PGE) evaluation was performed in the 3rd month and 4th year of the treatment. There were no statistically significant differences for Group I's resting VAS value between pre-treatment controls and controls in the 3rd week and 3rd month, no statistically significant differences were detected for Group II in passive flexion between pre-treatment and the 4th year, also in passive external rotation between pre-treatment and 3rd week (P > 0.05). A statistically significant recovery was detected in both groups in all the other evaluation parameters (P < 0.05). When evaluation was performed among groups, active abduction in the control in the 3rd month, VAS by movement and a statistically significant difference in favor of Group I in FE were determined (P < 0.05). No statistically significant differences were found among groups in PGE (P > 0.05). It was concluded that physical therapy modalities and SH application supplemented by home exercise programs were similar effects in short- and long term for ST which causes pain in shoulder and SH application may be a better alternative with regard to effectiveness and side effects for other treatment methods applied intraarticulary.

Comparison of ultrasound and ketoprofen phonophoresis in the treatment of carpal tunnel syndrome.

OBJECTIVE: The aim of this study was to compare the efficacy of ultrasound (US) and ketoprofen phonophoresis (PH) in the treatment of carpal tunnel syndrome (CTS). DESIGN: This study was a prospective, randomised, controlled, double-blinded clinical trial with follow-up at 8 weeks. Fiftyone patients (76 median nerves) with clinical and electrophysiologic evidence of mild or moderate CTS were included in the study. They were randomly assigned to one of three groups; group 1 received sham US and splinting, group 2 received US and splinting, and group 3 received ketoprofen phonophoresis and splinting. Patients were evaluated by use of electrophysiological variables such as median motor distal latency (mMDL), median sensory distal latency (mSDL), functional status scale (FSS), symptom severity scale (SSS) and visual analog scale (VAS). Electrophysiological variables and scales were evaluated at the beginning, end of therapy (2nd week) and 8th week. RESULTS: All the randomised patients were included in the intention-to-treat (ITT) analysis. The per protocol (PP) analysis included only those patients who complied with the study protocol. After completing 2 weeks of treatment, seven out of 51 randomized patients did not finish the study protocol due to non-compliance to splinting, illness and lost to follow-up. Those patients were excluded from PP analysis. Participants were similar in all clinical, electrophysiological and demographic respects (p>0.05). An improvement was found in all parameters (VAS, FSS, SSS, mMDL and mSDL) for all groups at the end of the treatment and 8th week. It was found that pain score was significantly lower in group 3 compared to other treatment groups at 8th week according to ITT and PP analysis (p= 0.002, p=0.004 and p=0.001, p=0.001). CONCLUSION: Ketoprofen PH as adjuvant therapy on splinting is effective with respect to reduction of pain. Adding US therapy to the splinting is not superior to the splinting alone in patients with CTS.

Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial.

OBJECTIVE: To assess the effectiveness of therapeutic exercises alone and in combination with a single physical agent - ultrasound - in patients with lumbar spinal stenosis. DESIGN: Randomized, prospective, controlled trial. SETTING: Department of Physical Medicine and Rehabilitation, University Hospital. SUBJECTS: Forty-five patients presenting with symptoms of neurological claudication and magnetic resonance image-proven lumbar spinal stenosis were assigned to one of three groups: ultrasound plus exercise group (group 1, n =15), sham ultrasound plus exercise group (group 2, n= 15) and no exercise - no treatment group (control group, n = 15). INTERVENTIONS: Stretching and strengthening exercises for lumbar, abdominal, leg muscles as well as low-intensity cycling exercises were given as therapeutic exercises. Ultrasound was applied with 1 mHz, 1.5 W/cm(2) intensity, in continuous mode on the back muscle for 10 minutes in group 1 while ultrasound on/off mode was applied in group 2. MAIN OUTCOME MEASURES: Before and after a three-week period, all subjects were evaluated by pain, disability, functional capacity and consumption of analgesic. RESULTS: Thirty-two of the participants were women and 13 were men, with an average age of 53.2 +/- 12.68 years (range 25-82 years). After a three-week treatment period, leg pain decreased in group 1 (-1.47 +/- 3.02) and group 2 (-2.47 +/- 3.75) compared with the control group (P<0.05). Disability score decreased in group 1 (-3.94 +/- 7.20) and group 2 (-7.80 +/- 10.26) compared with control group (P<0.05). We did not find any statistically significant difference between groups 1 and 2 (P>0.05). The amount of analgesic consumption is significantly less in the group with ultrasound application compared to that in the control group (P<0.05). CONCLUSION: The results of our study suggest that therapeutic exercises are effective for pain and disability in patients with lumbar spinal stenosis and that addition of ultrasound to exercise therapy lowers the analgesic intake substantially.

Successful treatment with adalimumab in a patient with coexisting Behçet's disease and ankylosing spondylitis.

The objective is to report a patient with concomitant ankylosing spondylitis (AS) and Behçet's disease (BD) successfully treated with adalimumab. A 44-year-old male diagnosed as AS applied to our outpatient clinic with complaints of morning stiffness, pain and limitation of motion at spine, concurrence of oral and genital ulcerated lesions. He was on sulfasalazine together with different NSAIDs for the past 1 year. According to the criteria of International Study Group, he was diagnosed as BD. The patient was considered as refractory to current treatment and adalimumab treatment was started. During follow-up, not only AS was in remission, but also no new oral and genital ulcerations appeared. There were no complications related to the use of anti-TNFalpha therapy. In our case it was observed that anti-TNFalpha therapy, specifically adalimumab, was effective for symptoms of both AS and BD.

Health-related quality of life (Nottingham Health Profile) in knee osteoarthritis: correlation with clinical variables and self-reported disability.

The aims of this study were to assess the health-related quality of life (HRQoL) in patients with knee osteoarthritis (OA) using the Nottingham Health Profile (NHP) and to determine its relationships with conventional clinical measures and self-reported disability. One hundred and forty patients with knee OA (104 female, 36 male, mean age 59.39 ± 7.62 years, mean disease duration 58.56 ± 56.78 months) and 40 sex and age-matched controls were included in the study. HRQoL, disability and pain were assessed using NHP, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), respectively. Results showed that the six subgroups of the NHP revealed higher scores in the knee OA patients compared with controls (p < 0.001). All subgroups of the NHP significantly correlated to VAS-rest, VAS-activity, 15-m walk test and WOMAC scores (p < 0.05, p < 0.01, p < 0.005, p < 0.001, respectively). The knee flexion or restricted extension range of motion was significantly correlated with the pain, energy and physical mobility subgroups of the NHP (p < 0.05, p < 0.005). Although there were statistically significant correlations between the NHP pain, emotional reaction, and physical mobility subgroup scores and body mass index (BMI) (p < 0.01, p < 0.05, p < 0.05, respectively), there were no correlations between all the NHP scores and duration of disease (p > 0.05). We conclude that patients with knee osteoarthritis undergo a significant impact on multiple dimensions of HRQoL, compared with healthy controls. The NHP is related to the clinical status and functional ability of patients with knee OA, and it can be used as a sensitive health status measure for clinical evaluation.

The effects of aerobic and resistance exercises in obese women.

OBJECTIVE: To compare the effects of aerobic and resistance exercise on weight, muscle strength, cardiovascular fitness, blood pressure and mood in obese women who were not on an energy-restricted diet. DESIGN: Randomized, prospective, controlled trial. SETTING: Department of Physical Medicine and Rehabilitation, University Hospital. SUBJECTS: Sixty obese women were assigned to one of three groups: aerobic exercise (n = 20), resistance exercise (n = 20) and control group (n = 20). INTERVENTIONS: The aerobic exercise group performed both walking and leg cycle exercise with increasing duration and frequency. The resistance exercise group performed progressive weight-resistance exercises for the upper and lower body. MAIN OUTCOME MEASURES: Before and after a 12-week period, all subjects were evaluated by anthropometric measurement, rating of mood, cardiorespiratory capacity and maximum strength of trained muscles. RESULTS: After a 12-week training period, subjects in the resistance group showed significant improvement in one-repetition maximum test of hip abductors (7.95+/-3.58 kg), quadriceps (14+/-7.18 kg), biceps (3.37+/- 2.84 kg) and pectorals (8.75+/-5.09 kg) compared with those in the control group (P < 0.001). VO2 max increased (0.51+/-0.40) and Beck Depression Scale scores decreased (-5.40+/-4.27) in the aerobic exercise group compared with the control group, significantly (P < 0.001). Only in hip abductor muscle strength was there a significant increase in the resistance exercise group compared with the aerobic exercise group (P < 0.05). CONCLUSION: Both aerobic exercise and resistance exercise resulted in improved performance and exercise capacity in obese women. While aerobic exercise appeared to be beneficial with regard to improving depressive symptoms and maximum oxygen consumption, resistance exercise was beneficial in increasing muscle strength.

The effects of postmenopausal Vitamin D treatment on vaginal atrophy.

OBJECTIVES: To evaluate the efficacy of Vitamin D for relieving vaginal atrophy. METHODS: In our cross-sectional study, 60 eligible women were consecutively identified among patients who were followed in physical medicine and rehabilitation's outpatient clinic, during the period March June 2001. The sample consisted of 30 postmenopausal women on 1,25-dihydroxy Vitamin D (calcitriol) treatment, 30 postmenopausal women taking neither hormone replacement nor osteoporosis treatment. Vaginal atrophy was determined by symptoms, physical examination and maturation index (MI). RESULTS: The mean physical findings score in Vitamin D treatment (VDT) group was significantly lower than the mean physical findings score in the group without treatment. Symptom scores were lower in both groups and there was not significantly difference between two groups. As maturation indices: in VDT group, superficial cells proportion was significantly higher and basal, parabasal cells proportion was lower than in the group without treatment. CONCLUSION: The results of current study seem to indicate that vaginal tissue may be a new target organ for therapeutically applied Vitamin D analogues.

Efficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction.

OBJECTIVE: To assess the efficacy of vestibular rehabilitation exercises on patients with chronic unilateral vestibular dysfunction. DESIGN: Prospective study. SETTING: Physical Medicine and Rehabilitation Clinic and Otolaryngology Clinic of a tertiary referral hospital. SUBJECTS: One-hundred and twenty-five patients with unilateral chronic vestibular dysfunction were included in the study. INTERVENTIONS: Eight-week, two-staged (clinic and home) vestibular rehabilitation programme with components of Cawthorne-Cooksey and Norre exercises was applied. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory (DHI) and visual analogue scale (VAS) were completed three times (at the beginning, end of the second week and end of the treatment). RESULTS: Data for 112 patients in the first stage and 93 patients in the second stage were evaluated because of insufficient compliance of the other patients. The mean DHI score was decreased from 50.42 +/- 24.12 points to 21.21 +/- 15.97 points (p < 0.001) at the end of first two weeks, and to 19.93 +/- 19.33 points at the end of the whole treatment. The mean VAS score was decreased from 5.87 +/- 2.27 to 2.02 +/- 1.75 (p < 0.001) at the end of second week, and to 1.51 +/- 1.29 at the end of eighth week. In respect to both VAS and DHI scores, improvement was noted in 67 patients (77.4%). Age, gender and disability level had no predictive value about therapy outcome. CONCLUSIONS: There was a fast recovery in the supervised exercise session, whereas there was no significant difference in the home exercise session. These findings suggest that either supervised exercise is better than home exercise or that 10 supervised sessions are sufficient to get the end result.